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Paul R. Houchens

FSA, MAAA
Principal, Consulting Actuary
Indianapolis, IN, US
Paul is a principal and consulting actuary with the Indianapolis office of Milliman. He joined the firm in 2002.
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Experience

Paul has extensive experience evaluating health care reform proposals from the prospective of numerous sectors of the healthcare industry, including: State Medicaid agencies, employers, health insurers, and other state agencies.

Paul has assisted five states in analyzing or projecting insurance market changes as a result of the Affordable Care Act. Additionally, he recently performed an actuarial certification for a state’s Section 1332 State Innovation Waiver. He has published numerous white papers on healthcare reform issues including the individual and employer mandates, insurer financial results under the Affordable Care Act, and evaluation of proposed federal legislation.

He has consulted on a wide array of topics for state Medicaid agencies, including capitation rate development, financial projections, risk adjustment, financial reporting, and encounter data quality improvement. Paul authored and assisted in the development of several white papers during 2016 related to the new Medicaid managed care regulations released by the Federal government.

Publications

Read their latest work

Article

Final Rule CMS-2439-F: Medicaid medical loss ratio standards

01 August 2024 - by Paul R. Houchens, Amber Kerstiens, Amber Kocher, Casey Szulc
Updates to reporting standards for Medicaid medical loss ratios are set to alter the landscape of state agency monitoring and managed care financial reporting.
Article

Medicaid reimbursement options to address social risks and health related social needs

07 February 2024 - by Paul R. Houchens, Kelsey Hiegel, Michael Kornhauser, Amanda Schipp, Katherine Wentworth
We present some options for consideration for Kentucky’s Department for Medicaid Services to better account for social risk and health-related social needs.
Article

Medicaid unwinding: options for states to help people with serious mental illness maintain treatment access

27 July 2023 - by David T. Applegate, Jessica Bertolo, Katherine Wentworth, Paul R. Houchens, Amrutha Pulikottil
We examine strategies states can consider to support the reenrollment in Medicaid for individuals with SMI and ways to help smooth their transition to other coverage sources.
Article

2023 Milliman Medical Index

25 May 2023 - by Deana Bell, Mike Gaal, Paul R. Houchens, David M. Liner, Annie Man, Andrew L. Naugle, Doug Norris
We project the average cost of healthcare for an American family of four with an employer-sponsored PPO plan to rise to $31,065 in 2023, up 5.6% over last year.
Article

The expanding use of in-lieu-of services and implications of CMS guidance

27 March 2023 - by Jessica Bertolo, Libby Bunzli, Mat DeLillo, Paul R. Houchens, Mary Pat Stemnock
We review recent guidance by CMS on the use of in-lieu-of-services for Medicaid managed care.
Article

Potential coverage gaps among Medicaid beneficiaries with serious mental illness

07 March 2023 - by David T. Applegate, Jessica Bertolo, Katherine Wentworth, Paul R. Houchens, Amrutha Pulikottil
With the end of the COVID-19 public health emergency, Medicaid disenrollment could mean healthcare gaps for people with serious mental illness.
Article

Commercial health insurance: Detailed 2020 financial results and emerging 2021 trends

19 July 2022 - by Paul R. Houchens, Zach Hunt
We review the financial results of the commercial health insurance industry in 2020, with a focus on healthcare market changes and emerging trends.
Article

Evaluation of State Medicaid Scorecard data: 2021 Scorecard update

31 May 2022 - by Paul R. Houchens, Liam Plunkitt
This report provides an analysis of the recently released 2020 Centers for Medicare and Medicaid Services (CMS) Medicaid and Children’s Health Insurance Program (CHIP) Scorecard.
Article

2022 Milliman Medical Index

25 May 2022 - by Mike Gaal, Paul R. Houchens, David M. Liner, Annie Man, Andrew L. Naugle, Doug Norris
In 2022, the cost of healthcare for a hypothetical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $30,260, according to the Milliman Medical Index (MMI).
Article

Health equity data strategy and applications in Medicaid managed care

13 May 2022 - by Paul R. Houchens, Penny Edlund, Libby Bunzli
A summary of available data sources that can assist state Medicaid agencies in evaluating health disparities and measuring progress toward health equity goals